Butler C, Rollnick S, Stott N
Department of General Practice, College of Medicine, University of Wales, Llanedeyrn Health Centre, Cardiff, Wales.
CMAJ. 1996 May 1;154(9):1357-62.
Despite the explosion of research into the effect of medical advice on patient behaviour, only about 50% of patients comply with long-term drug regimens. And when it comes to changes in lifestyle, the percentage of patients who comply with medical advice often falls to single figures. Review articles on compliance have traditionally concentrated on factors that make it easier for patients to adhere to medical advice. However, recent articles urge clinicians to be more understanding of the wider implications of compliance in their patients' lives. This article focuses on how clinicians' consulting methods can affect patients' behaviour. Specifically, the authors consider the patient-centred clinical method as well as insights from and consulting techniques pioneered in the addictions field that can help to bring ambivalent patients closer to decisions about change. Instead of seeing resistance to change as rooted entirely in the patient, the authors view it as stemming partly from the way clinicians talk to patients. An advice-giving approach is usually inadequate to motivate people to embark on major lifestyle changes. Instead, the authors propose a negotiation-based framework that harnesses patients' intrinsic motivation to make their own decisions. This approach also promotes clinicians' acceptance of patients' decisions, even if these decisions run counter to current medical wisdom.
尽管关于医疗建议对患者行为影响的研究激增，但只有约50%的患者遵守长期药物治疗方案。而在生活方式改变方面，遵守医疗建议的患者比例往往降至个位数。传统上，关于依从性的综述文章集中在使患者更容易坚持医疗建议的因素上。然而，最近的文章敦促临床医生更全面地理解依从性在患者生活中的广泛影响。本文重点关注临床医生的咨询方法如何影响患者的行为。具体而言，作者考虑了以患者为中心的临床方法，以及成瘾领域开创的见解和咨询技巧，这些有助于让矛盾心理的患者更接近做出改变的决定。作者认为，对改变的抵触并非完全源于患者自身，部分原因在于临床医生与患者交谈的方式。单纯的建议方式通常不足以激励人们进行重大的生活方式改变。相反，作者提出了一个基于协商的框架，利用患者的内在动力来做出自己的决定。这种方法还促进临床医生接受患者的决定，即使这些决定与当前的医学观念相悖。
